Evaluating the outcomes of low vision rehabilitation

The requirement for those providing healthcare to measure outcomes raises the fundamental question of how these should be measured. Both the scale of the low vision population and the different models of care proposed make it a pressing need to determine outcomes using valid and reliable measures. In this study we describe the development and piloting of a questionnaire designed to meet this requirement. The questionnaire was piloted on 56 subjects with age-related macular degeneration (ARMD). Test-retest reliability of the questionnaire was estimated using a further sample of 28 subjects with ARMD. Pilot testing confirmed the feasibility of administering the questionnaire to an elderly population with ARMD. A total of 87% of the sample reported using an LVA (65% on a daily basis), predominantly for a reading task. The number of tasks an LVA was used for, its frequency of use, length of continuous use and ease of use are significantly associated with the rating of an LVA as important/less important ( P <0.0001), but the acuity achieved with the device is not significantly associated with rated importance ( P =0.11), reinforcing doubt about the validity of visual function outcomes. The limitations of this pilot study and earlier case series in describing the outcomes of low vision care are discussed and a randomised controlled trial using a broad range of outcomes is proposed in order to fully describe the effectiveness of low vision rehabilitation and inform the debate about models of care.     

中国大陆三级医疗机构低视力服务专业人员配置和服务提供情况分析

目的：统计分析我国三级医疗机构低视力服务专业人员配置和服务提供情况，为进一步推进我国低视力医疗康复工作提供参考依据。方法：描述性研究。于2015 年开始对全国提供眼科服务的三级医疗机构通过网上填报的方式进行普查，采用描述性统计方法和χ2检验，对我国三级医疗机构低视力服务专业人员配置和服务提供情况进行系统整理和统计分析。结果：本次调查覆盖全国1 508 家三级医疗机构，其中提供低视力诊疗康复服务的有559 家（37.07%），未提供服务的有949 家（62.93%），各级医疗机构在是否开展低视力康复服务方面差异有统计学意义（χ2=61.94，P<0.001）。在提供服务的机构中，已设立低视力专业门诊的有338家（60.47%），低视力年平均门诊量为964例。从事低视力医疗康复服务专业人员2 993 人，平均每家三级医疗机构有低视力专业医师1.98 人、护士0.46 人、技师0.41 人、辅助人员0.22 人。三级医疗机构以儿童功能性视力康复训练、低视力社区教育宣传和助视器验配为主要低视力服务类型。结论：我国三级医疗机构低视力学科建设亟待加强，专业人员总量偏低、人才梯队建设不完善，服务质量低、服务类型单一，无法满足我国低视力患者全方位的服务需求。     

Use and non-use of low vision aids by visually impaired children

The results of this study indicated that children do use and benefit from low vision aids and that the child's need for near low vision aids can be predicted from their age, unmagnified reading performance, and visual field characteristics. The use of distance monoculars is less easily predicted. However, many visually impaired children both in mainstream special units and in schools for the blind are not being supplied appropriate low vision aids (LVAs). Many have not had an LVA assessment within 1 year and others are experiencing difficulties with LVAs that could be eliminated or reduced.     

Low vision aid–A ray of hope for irreversible visual loss in the pediatric age group

Purpose:

To analyze visual acuity (VA) improvement, causes of low vision (LV), and quality of life (QOL) following the use of low vision aids (LVAs) in children with LV.

Methods:

A prospective analysis was conducted on children with LV aged between 4 years and 18 years between March 2013 and October 2013. Children were recruited from both urban schools and rural schools. LVAs were tried for visual improvement, and improved VA was noted. All children were trained to use the aid and followed up monthly for 3 consecutive months for VA improvement; QOL through a questionnaire was analyzed after the use of LVAs.

Results:

A total of 74 children (148 eyes; 50% male; mean age, 11.8 ± 3.2 years) were analyzed, where 34 children were recruited from rural areas and 40 from urban schools. After LVA use, 101 (68.24%) eyes of 59 (79.72%) children improved for distance with telescope and 81 (54.72%) eyes of 51 (68.91%) children improved for near with magnifiers. LV due to retinal problems, optic atrophy, congenital anomalies, and amblyopia drastically reduced after use of LVA. A statistically significantly higher proportion of children had either “excellent” or “good” QOL, and a significantly lower proportion of children had either “not satisfactory” or “poor” QOL after the use of LVA (p < 0.0001).

Conclusion:

LVA is essential and effective in improving VA and QOL in children with LV.     

The experience of a university-based low vision clinic

An open low vision clinic has been in operation at University of Wales College of Cardiff, Department of Optometry for 5 years. This paper describes the demography and visual characteristics of 218 consecutively presenting patients. A detailed survey of the aids prescribed is conducted. A significant proportion of low vision patients required only simple aids (56.8%) and low magnification (71.6%). It is suggested that these patients could be assisted in an optometric practice. In addition, visual acuity, distance or near is not a good indicator of eventual visual performance with an LVA. Therefore, it was concluded that all patients having measurable form vision should receive a low vision assessment.     

Color vision characteristics of visually impaired children

A classroom assessment of color vision characteristics of children with low vision was conducted using a battery of tests. The results showed 75% of the children failed one or more tests, although only 24% had a moderate or severe color vision defect. Comparisons with the low vision clinic color vision assessment showed that many of the children were not identified as being color vision defective. Considering the use of color-coded information in education, greater emphasis on color vision evaluations in routine low vision examinations is recommended.     

儿童盲和低视力的病因与屈光状态及远用助视器康复研究

目的：分析儿童盲和低视力的病因、屈光状态、屈光矫正和配用光学远用助视器矫正后的视力情况。

方法：选取2015-12/2018-04我科门诊接诊及盲校筛查的6～16岁低视力儿童和盲童212例422眼,通过相关检查明确病因和屈光状态,对部分患儿进行屈光矫正和光学远用助视器验配矫正,分析矫正后视力情况。

结果：儿童盲和低视力病因以先天性和遗传性眼病为主,本组病例中先天性白内障是首位原因(19.3%),低视力屈光不正以轻中度远视和近视多见(65.3%),屈光矫正后脱盲率(26.4%)和脱残率(14.6%)均低于联合远用助视器验配矫正后的脱盲率(58.3%)和脱残率(91.1%),差异均有统计学意义(P<0.01)。

结论：儿童盲和低视力病因复杂,应加强预防和筛查工作,低视力儿童应常规进行屈光矫正并配合使用远用助视器矫正,以利获得满意的康复效果。     

Characteristics of a paediatric low vision population in a private eye hospital in India.

While private hospitals provide an important access point for low vision services for children in urban India, little is known about this service delivery route. A cross sectional survey was done of consecutive records of 220 children presenting at a newly opened paediatric low vision centre in a private eye hospital in Hyderabad. On presentation, 49% of the children were classified as moderately visually impaired, 31% were severely visually impaired and 20% were blind. The four major causes of visual impairment were the hereditary/genetic conditions of congenital glaucoma, hereditary macular degeneration, retinitis pigmentosa and albinism. Approach magnification was sufficient for required near tasks in all pre-school children and about 50% of school children. Provision of a distance refraction decreased the prevalence of severe visual impairment and blindness by 31%. The most commonly prescribed low vision devices were spectacles indicating a key role for optometry in the management of visual impairment in Indian children. Establishment of low vision clinics in existing Indian eye hospitals using associated optometric staff would be a cost effective method to minimise visual impairment in Indian children.     

How effective is an integrated approach to low vision rehabilitation? Two year follow up results from south Devon.

AIMS--A survey was undertaken to assess the effectiveness of an integrated approach to the provision of low visual aids (LVAs) in south Devon over a 2 year follow up period. This integrated approach includes the assessment of patient needs by low vision therapists, followed by the provision of suitable LVAs, with particular emphasis on training in their use. METHODS--A total of 125 patients were selected at random from the 445 patients seen in the low vision clinic at Torbay Hospital in the year 1991. These patients were sent questionnaires relating to the service over a 2 year period. Questionnaires from 111 patients were analysed at 1 year and 75 questionnaires together with 46 clinical reassessments, after 2 years. RESULTS--Using a similar questionnaire to one used in a previous study in the UK from a unit where LVA training was not provided, not only was a higher rate of satisfaction found with the services provided, but also the LVAs dispensed were used more frequently. The majority of the LVAs provided were of the simple, inexpensive variety and wastage was very low. CONCLUSIONS--It was concluded that this integrated approach to low vision rehabilitation with emphasis on training in the use of less complex LVAs exceeds the performance of other types of service that rely on the dispensing of more complex LVAs.     

Perspectives on low vision service in Canada: a pilot study

BACKGROUND: A review of the literature and current practice patterns for vision rehabilitation care in Canada provide a basis for this pilot study, which was undertaken to explore related issues from the perspectives of older adults and low vision service providers. The pilot study was overseen by a number of collaborators whose names are listed at the end of this paper. METHODS: Thirty people aged 60 years or older who had vision impairments and were clients of the Canadian National Institute for the Blind were surveyed by telephone. Ophthalmologists, optometrists, and opticians completed a mail questionnaire. Vision rehabilitation practitioners and nurses, ophthalmic technicians, and service providers for low vision technical aids were surveyed by e-mail. RESULTS: Ophthalmologists are a primary source of referrals to low vision services, but low functional vision does not always trigger such referrals, nor are referrals always timely. Optometrists are primary providers of low vision services, including dispensing of low vision aids, but such aids are expensive, and inadequate training in their use may contribute to noncompliance. Costs associated with providing low vision assessments and services are higher than compensation to vision service providers, whose capacity to meet increasing demand is limited. In addition, there are disparities between rural and urban areas and among provinces in the availability of, and funding for, services and aids. INTERPRETATION: On the basis of the findings, an emergent theory is proposed on the consequences resulting from lack of planning and standards for vision rehabilitation care. The implications of this study form the basis for further research.     

Profile of patients presenting at a low vision clinic in a developing country

ABSTRACT: BACKGROUND: Low vision is an important public health problem;however, very few low vision clinics are available to address the needs of low vision patientsin most developing countries. The purpose of this study was to describe the characteristics of patients attending the low vision clinic of a Nigerian tertiary hospital. METHODS: This was a prospective cross sectional study of all new patients seen at the low vision clinic over a 36 month period. Patients were administered with a structured questionnaire, and were examined and tested with low vision devices by the attending low vision specialist. Information on the demographic and clinical characteristics of the patients was recorded. RESULTS: A total of 193 new patients seen during the period were studied. The mean age was 41.4 years, and their ages ranged between 6 and 90 years with a male to female ratio of 1.9:1. Majority (58%) were aged below 50 years, 23.3% were children ([less than or equal to]15 years), while 21.8% were elderly patients ([greater than or equal to]65 years). The commonest cause of low vision was retinitis pigmentosa (16.6%); 14.5% had age related macular degeneration (ARMD); 9.8% had albinism; while only 1% had diabetic retinopathy. ARMD(45.2%) was the commonest cause in the elderly patients, while albinism (24.4%) and optic atrophy (24.4%) were the commonest in children. CONCLUSION: The demographic and clinical characteristics of low vision patients seen in this clinicare similar to that of patients in other developing countries, but different from those in developed countries. Elderly patients and females may be under-utilising low vision services. There is a need for further research into the determinants of low vision service utilisation in developing countries. This would further aid the planning and delivery of services to low vision patients in these countries.     

土耳其低视力患者的病因及特征

目的：探讨土耳其配戴助视器的低视力患者的病因和特点,及其与父母近亲结婚是否有关系。 方法：回顾性研究了2009/2013年间伊斯坦布尔诊所接受236例低视力患者。分析年龄、性别分布、低视力原因、近亲结婚、低视力辅助类型规定及视力变化。在回顾性研究中,根据世界卫生组织定义基于最佳矫正视力将视力分为（失明,视力〈20/400;视力严重受损,视力〈20/200～20/400;视力轻度到中度受损,视力〈20/60～20/200）。基于双眼主要病因,根据国际疾病分类第十版可以确定失明和低视力的病因。根据视力和患者需求规定了视力辅助,并使用平均值依标准差和频率对数据进行了描述。 结果：研究包括236例患者,65%为男性,平均年龄为38.5依24.2岁（年龄范围6～95岁）,男性多于女性。年龄在15～30岁（35.6%）之间是最大的年龄群体。轻度至中度视力受损患者为122例,严重视力受损患者为84例,失明患者为30例,他们分别占总人数的51.6%、35.6%和12.7%。脉络膜疾病和视网膜疾病（62.7%）是导致视力低下的主要原因。老年低视力患者黄斑变性逐渐成为视力低下的首要原因（61.3%）。造成视力低下的原因有视网膜和脉络膜疾病（62.7%）,眼球震颤（23.7%）,视神经和视神经束疾病（11%）,先天性白内障（0.8%）及青光眼（1.7%）。88例患者（37.3%）为伽利略类型,116例患者（49.2%）为开普勒类型。18例患者（7.6%）在接受LVA后视力无明显改善。14例患者被准许使用放大镜矫正视力。在大多数患者中,使用LVA的近视和远视患者视力均得到改善。62例近亲结婚患者占总人数的26.3%。 结论：14岁以上患者视力受损主要原因是视网膜和脉络膜疾病,15岁以下的患者常见原因为眼球震颤。在近亲结婚群体中黄斑营养不良和色素性视网膜炎患者显著增高。研究疾病病因学的遗传非常有效,因此,近亲结婚在土耳其仍是一大问题。     

老年低视力患者生活质量与护理服务需求的研究

目的：通过调查老年低视力患者的生活质量及其护理服务需求,为提高和改善老年低视力群体的生活质量提供理论依据。

方法：采用横断面的研究方法,以福州市某三甲医院老年低视力患者200例为研究对象,采用中文版低视力生活质量量表(CLVQOL)、护理服务需求问卷表进行调查。

结果：老年低视力患者生活质量得分为54.92±12.11分,护理服务需求得分为30.34±8.93分,中、高需求者为88%。生存质量与护理服务需求呈负相关(r = -0.266,P<0.01)。

结论：老年低视力患者的生活质量水平较低,护理服务需求高,尤其是视功能康复训练方面的护理服务需求。针对我国面临老龄化日趋严重的重要社会问题,重视老年低视力群体的护理服务需求,探讨提供精准的视觉护理服务干预,提高其生活质量是非常必要的。     

低视力门诊患者的特征及视觉康复需求

目的探讨低视力患者的视觉康复需求以及拒绝视觉康复的原因,为推广低视力视觉康复模式提供参考。方法回顾性病例研究。收集2013年7月至2014年7月来温州医科大学附属眼视光医院就诊的低视力患者361例,年龄（44.2±23.0）岁,男193例,女168例,主要来自院内转诊（68.5%）。对视力损伤的病因、患者对视觉康复的需求、视觉康复的有效性进行统计和分析。结果20岁以下低视力患者的病因主要是先天性白内障（30.7%）和眼球震颤（28.0%）;20岁及以上主要是病理性近视（25.5%）和其他视网膜疾病（25.2%）。88.2%的患者有视觉康复需求,远视力康复的首要、次要需求是娱乐休闲活动;近视力康复的首要需求是娱乐休闲活动,次要需求是阅读。患者助视器接受率为59.4%,93.6%患者拒绝的原因是仍希望能通过手术、药物等治疗方式改善视功能。结论娱乐休闲活动是温州医科大学附属眼视光医院低视力门诊患者视觉康复的首要需求,制定融合娱乐休闲活动的低视力康复策略可能是一种有效的康复方法。     

Vision screening survey of all children starting primary school in 1998 in the Federal State of Saarland,Germany

BACKGROUND. The excellent co-operation with the pediatric public health service of the local health authorities enables us to present the collected results of a vision screening survey of all children starting primary school in 1998 in the Federal State of Saarland. The aim is to analyze the prevalence of amblyopia, strabismus, reduced visual acuity, refractive errors and severe visual impairment in one complete grade of pre-schoolers. METHODS. The examination parameters had been determined in co-operation with the Department of Pediatric Ophthalmology at the University of Saarland and had been fitted to the needs and abilities of lay persons (health workers) doing a vision screening as part of a general health check-up. Parameters were: visual acuity (Rodenstock R21), color vision (Ishihara), stereopsis (Lang), and test for latent hyperopia. Referral to an ophthalmologist if: visual acuity &;lt; 0.7; difference in visual acuity in both eyes of more than one line, or any other pathological test result. A total of 12,192 children were screened. RESULTS. The preventive pediatric examinations were complete in 5756 children (56.4%), incomplete in 4449 children (43.6%) and in 1987 children (16.3%) the degree of completion could not be determined. Eyes: pathological findings in 41.7%. Reduced visual acuity in 30.8%, color vision defects in 1.3%, severe visual impairment in 0.3%. Pathological findings in other organ systems: skeleton 33.5%, teeth 32.6%. For the urban confederacy of Saarbr?cken: referrals to ophthalmologists: n=1108. No feedback information: 380; refractive correction: 226; recommendation for regular checks: 346; no pathological findings: 156. CONCLUSION. The high percentage of pathological findings in the vision screening of 12,192 pre-schoolers is an important confirmation that there is a need for a preventive ophthalmologic examination before the age of six. Only an area-wide ophthalmologic vision screening around the second or third year of life can effectively reduce the high prevalence of pathological findings at the time of starting primary school. To improve the present screening situation, networks between ophthalmologists and pediatricians would be beneficial.     

Challenges in applying autofocus technology to low vision telescopes.

Autofocus (AF) low vision telescopes offer the potential to increase the acceptance and utilization of such low vision aids (LVA) by the visually impaired. Many patients resist conventional manual focus telescopes for a variety of reasons including appearance, field of view, weight, and utility. The elderly who comprise the significant part of the target population may also resist telescopes due to an avoidance of the technical challenge of its use. Although an AF telescope is technically advanced, it may allow for less manipulation by the wearer and hence enable its more effective application to visual tasks, especially in the near- to mid-range where depths of field narrow and the demands for focusing increase. There are many challenges involved in the application of AF technology to LVA including modification of the focusing range, signal processing for physiologically acceptable performance, and power and weight considerations. A preliminary infrared (IR) AF prototype based upon our recent work with the Ocutech Vision Enhancing System (VES) has been produced. Initial findings are presented which address the requirements of a subsequent version as well as the challenges that will be faced to optimize such a device.     

The Seoul Metropolitan Preschool Vision Screening Programme: results from South Korea

AIM: To report on a new model of preschool vision screening that was performed in metropolitan Seoul and to investigate the distribution of various ocular disorders in this metropolitan preschool population. METHODS: Vision screening was conducted on 36 973 kindergarten children aged 3-5 years in a stepwise manner. The first step was home screening using a set of five picture cards and a questionnaire. The children who did not pass the first step (VA <0.5 in at least one eye or any abnormal responses on the questionnaire) were retested with regular vision charts at the regional public healthcare centres. After this retest, some children were referred to ophthalmologists. The referral criteria for visual acuity were <0.5 at 3 years and <0.63 at 4 or 5 years in at least one eye. RESULTS: Of those screened, 7116 (19.2%) children did not pass the home screening tests and 2058 (28.9%) out of the 7116 were referred. The results of the ophthalmological examination in eye clinics were only available for 894 children (43.4%) of those who were referred. The rest of the children did not visit ophthalmologists because they had been checked at an eye clinic, were currently under treatment, or for personal reasons. Refractive errors were found in 608 (1.6%) children. Astigmatism was associated in 78.2% of ametropes. Amblyopia was discovered in 149 (0.4%) children and refractive error was the major aetiology with a predominant rate (82.5%). Manifest strabismus was detected in 52 children. The positive predictive value of vision screening for any ophthalmological disorder was 0.77, and 0.49 for significant disorders requiring treatment. CONCLUSIONS: This preschool vision screening model was highly accessible to the children and their parents, easy to administer, and effective to detect a variety of ocular disorders. However, the participation rate of the referred children in the examinations by ophthalmologists was quite low. The performance and efficiency of this screening programme need to be optimised with further revision.